HSV Flashcards
what is HSV?
Herpes simplex viruses are large double-stranded DNA viruses. They are part of the herpes virus family, and predominantly cause oral, genital and ocular manifestations.
what are primary _ recurrent HS infections?
Primary infection is the first-time exposure to HSV in a seronegative (unexposed) person.
Recurrent infection is the reactivation of HSV, causing repeated symptoms.
aetiology of HSV infections?
HSV-1, causing oral, genital or ocular herpes
HSV-2, which usually causes genital herpes
Following initial infection, HSV becomes latent in the sensory ganglia and can subsequently reactivate, known as shingles.
HSV is transmitted at mucosal surfaces or breaks in the skin.
feature of HSV infection?
Oral: single painful ulcer along the lip border or gingivostomatitis
Genital: multiple painful vesicular lesions progressing to ulceration & crusted lesions, dysuria
Ocular: eye pain, irritation or photophobia, eye watering, blurred vision, acute red eye, visible vesicles around the eye, corneal abnormalities
Lymphadenopathy, malaise, fever
Tingling sensation or painful before lesion appears
ix for oral HSV infections?
For simple oral lesions, a clinical diagnosis will usually suffice
ix for genital HSV infections?
viral swab for PCR
what further ix are required for HSV?
Recurrent or unresolving lesions - suggesting an underlying cause or alternative diagnosis
If the patient is immunocompromised
Ocular herpes - requiring an examination with fluoroscein stain and visual acuity testing with subsequent slit-lamp examination & viral culture/PCR
During pregnancy - serology may be needed to differentiate between primary infection and reactivation
who goes w=to hospital with HSV/
Patients who are systemically unwell, present with ocular herpes or are unable to tolerate fluids should have an emergency referral to hospital for urgent assessment and systemic treatment. Referral is also indicated for suspected malignancy, patients at risk of dehydration, pregnant (see below), immunocompromised or recurrent or unresolving lesions.
general HSV management?
Genital herpes requires oral aciclovir and a referral to GUM services. Recurrence with no risk of complications can be managed with self-care measures alone.
Oral herpes is usually treated with topical antivirals
Ocular herpes requires specialist management typically involving oral or topical antivirals.
Symptomatic management may involve analgesia, topical lidocaine, maintaining adequate hydration and wearing loose clothing. Measures to reduce risk of transmission are also important.
HSV management in pregnancy?
Primary infection at less than 28 weeks’ gestation: aciclovir initially and regular prophylactic aciclovir from 38 weeks. Can consider vaginal delivery (specialist decision).
Primary infection at greater than 28 weeks’ gestation: aciclovir during initial infection followed by regular prophylactic aciclovir. Usually requires caesarean section delivery.
Recurrent HSV typically carries a lower risk of neonatal infection, but it is important to avoid a prolonged rupture of membranes and prophylactic aciclovir may be considered on specialist advice.
risk of HSV in pregnancy?
genital herpes in pregnancy has risk of neonatal herpes simplex infection, which can be very serious if left untreated.
complications of HSV infection?
Oral: dehydration, eczema herpeticum, adhesions, erythema multiforme, spread to trachea/lungs/oesophagus
Progressive multifocal coalescing lesions, urinary retention, increased risk of HIV infection, neonatal HSV
Ocular: corneal scarring damage & visual impairment
Secondary infection
Autoinoculation of other areas
Systemic infection including meningitis, encephalitis, hepatitis
